The purpose of this study is to determine whether a breast-conserving treatment program of limited surgery and definitive radiation offers equivalent local control and survival to mastectomy in patients with early stage breast cancer. After workup confirms localized disease, patients are randomly assigned to either primary surgery or primary irradiation. Patients treated with mastectomy are offered breast reconstruction. All patients undergo complete axillary node removal; those patients with pathologically positive lymph nodes, and those with negative nodes who are estrogen receptor negative receive chemotherapy.